GOITRE

The enlargement of the thyroid gland--goitre--is physiological during pregnancy, and is believed to be caused by the throwing into the maternal blood stream of special protein substances derived from the fetus. As just stated, this is more or less physiological, will usually pa.s.s away after the babe is born, and, therefore, need give the mother no particular concern. Tight neck bands should be replaced by low, comfortable ones. The bowels should move freely every day, and water drinking be increased as well as sweating of the skin encouraged by a short, hot bath, followed by the dry blanket pack, while the head is kept cool by compresses wrung from cold water. In this manner the elimination of these poisons is increased through both the skin and the kidneys.

BACKACHE

The backache of the later months of expectancy is very annoying and often spoils an otherwise restful night's sleep. This is probably also a pressure symptom, if the physician's a.n.a.lysis of the urine proves that the kidneys are not at fault. If you have electric lights in the home, a very useful contrivance can be made which will give you great relief. The light end of an extension cord, five to seven feet in length, is soldered into the center of the bottom of a bright, pressed tin pail about twelve inches in diameter at the top and nine or ten inches deep. With the bail removed, screw in a sixteen or thirty-two candle power bulb and attach the extension cord to a nearby wall or ceiling socket. This arrangement supplies radiant heat and is called a photoph.o.r.e (See Fig. 3). Apply this twofold remedial agent--light and heat combined--to the painful back (underneath the bed clothing) and our restless mother will go to sleep very quickly. This may safely be used as often and as long as desired.

[Ill.u.s.tration: Fig. 3. The Photoph.o.r.e.]

PERNICIOUS VOMITING

Persistent, prolonged, and very much aggravated cases of morning sickness are termed pernicious vomiting. The patient emaciates because of the lack of ability to keep food long enough to receive any benefits therefrom.

In treating these cases the sufferer should be put to bed in a room with many open windows, or, if the weather permit, should be out of doors on a comfortable cot. She should remain in bed one hour before the meal is served and from one to three hours afterward. The mind should be diverted from her condition by good reading, friends, or other amus.e.m.e.nts. The utmost care and tact should be used in the preparation of her food, and art should be manifested in the daintiness of the tray, etc. We found one mother was nauseated even at the sight of her tray and so we planned a call that should bring us to her home at the meal hour. The tray came in with the attendant in unkempt attire, who said, as she placed it carelessly down on a much-loved book our patient had been reading: "I heard you say you liked vegetable soup so I brought you a big bowl full." As I gazed at the tray, I saw a large, thick, gravy bowl running over with the soup.

I usually like vegetable soup, but at the sight of that sloppy looking bowl--well, I thought I should never care for it again.

After installing a new maid who had a sense of service and daintiness, and who took real pleasure in the selection of the dishes for the tray, as well as the quality and quant.i.ty of food served in them, our patient made speedy recovery, went on to full term and became a happy mother.

There is no doubt that the mind has very much to do with this vexing complication of pregnancy. One mother immediately stopped vomiting everything she ate when told by her husband that "the doctor said he was coming in the morning to take you away from me to the hospital if you didn't stop vomiting." Everything known should be tried for the relief of these patients and in extreme cases, when the mother's life is endangered, pregnancy should be terminated.

INSOMNIA

The neutral full bath, temperature 97 F., maintained for twenty minutes to one-half hour, should be taken just on going to bed. The patient must not talk--must rest in the bath--absolutely quiet. The causes of insomnia should be determined if possible, and proper measures employed to remove them. They may consist of backache, cramps, frequent urination, pressure of the uterus on the diaphragm or pressure against the sides of the abdomen. The bed should be large, thus giving the patient ample room to roll about.

The following procedures may be tried in an effort to relieve the sleeplessness:

Rubbing of the spine, alcohol or witch-hazel rubbing of the entire body, the neutral bath, or the application of the electric photoph.o.r.e--described a few pages back--may be made to the painful part. _Do not resort to drugs_, unless you are directed to do so by your physician.

HEADACHE

Headaches should not be allowed to continue un.o.bserved by the attending physician. Measure the daily output of urine, which should be at least three pints or two quarts. In case of daily or frequent headaches, notify your physician at once and take a twenty-four hour specimen of urine to him. Headache is an early symptom of retained poisons and if early reported to the physician quick relief can be given the patient and often severe kidney complications be avoided by the proper administration of early sweating procedures. Water drinking should be increased to two quarts (about ten gla.s.ses) a day. Less food and more water are the usual indications in the headaches of pregnancy.

HIGH BLOOD-PRESSURE

Blood-pressure is called _high_ when the systolic pressure registers above 150 to 160 millimeters of mercury. Pressure above 165 should be taken seriously and the patient should keep in close touch with her physician. Tri-weekly examinations of the urine should be made, while eliminating baths should be promptly inst.i.tuted. The subject of blood-pressure in relation to pregnancy will be fully dealt with in the next chapter--in connection with toxemia, eclampsia, etc.

CHAPTER VI

TOXEMIA AND ITS SYMPTOMS

At the close of the preceding chapter on the complications of pregnancy, brief mention was made of blood-pressure as a possible source of anxiety. This chapter will be devoted to a further discussion of the subjects of toxemia, eclampsia, convulsions, and especially blood-pressure--in connection with other leading symptoms of these serious complications of pregnancy.

TOXIC SYMPTOMS

In a former chapter we learned that the developing child nearly doubled its weight in the last two months of pregnancy. As the child grows, its metabolic waste matter is greatly increased, while all these poisonous substances must finally be eliminated by the mother.

Now, the mother's waste matter is of itself considerably increased; and so, if the kidneys, the liver, and the skin are already over-taxed in their work of normal elimination--if they are already doing their full quota of work--we can readily see that the additional waste matter of the unborn child will throw much extra work on the already overworked eliminative organs, and this results in a condition of toxemia. Certain symptoms accompany this state of const.i.tutional poisoning or auto-intoxication--the chief of which are:

1. Headache.

2. Dizziness.

3. Blurring of the vision.

4. Swelling of the feet and hands, or puffiness of the face.

5. Diminished urine.

6. Vomiting.

7. High blood-pressure.

8. Alb.u.min and casts in the urine.

Any one of these symptoms may or may not indicate toxemia; but it should be reported at once to the attending physician. In the presence of one or more of these symptoms an expectant mother is always safe, while awaiting the physician's advice, in carrying out the following program:

1. Drink more water or lemonade.

2. Take a mild cathartic.

3. Avoid eating much meat and other highly protein foods.

CONVULSIONS OF PREGNANCY

This serious complication of the last weeks of pregnancy demands immediate attention. They may almost invariably be avoided if the blood-pressure and the urine are studiously watched during the latter part of the expectant period.

If you are unable to get your physician at once, the following treatment should be administered immediately.

1. A hot colonic flushing (See Appendix).

2. A hot bath followed by the hot blanket pack (See Appendix).

3. One drop of croton oil on a bit of sugar may be placed on the back of the tongue.

4. Chloroform may be administered, provided a competent nurse or other medical person is present.

The appearance of convulsions which have been preceded by one or more of the symptoms noted under the head of "toxemia," indicates that the patient has become so profoundly intoxicated and poisoned by the acc.u.mulating toxins, that the lives of both mother and child are jeopardized by threatened eclampsia. At such a time, the attending physician will immediately set about to bring on labor, and thus seek to empty the uterus at the earliest possible moment.

CARDINAL SYMPTOMS OF TOXICITY

Since toxemia (eclampsia) is one of the complications of pregnancy most to be dreaded, it is fortunate that it almost invariably exhibits early danger signals which, if recognized and heeded, would enable the patient and physician to initiate proper measures to avert danger and escape the threatened disaster. The presence of this toxic danger is indicated by the persistent presence of the following three symptoms:

1. Persistent, dull headache.

2. Presence of casts in the urine.

3. Persistent high blood-pressure, with tendency to increase.

Of course, alb.u.min will probably appear in the urine along with the casts, but it is the continued appearance of the casts that is of more importance as a danger signal. Alb.u.min is quite common in the urine of the expectant mother, but casts--long continued--suggest trouble.